Provider Demographics
NPI:1245243682
Name:DILLOW, JERYL ERIC (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JERYL
Middle Name:ERIC
Last Name:DILLOW
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 MICOL LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3407
Mailing Address - Country:US
Mailing Address - Phone:336-996-7223
Mailing Address - Fax:
Practice Address - Street 1:1600 UNION CROSS RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7537
Practice Address - Country:US
Practice Address - Phone:336-771-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer